Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection
In an era of dwindling hospital resources and increasing medical costs, safe reduction in postoperative stay has become a major focus to optimize utilization of healthcare resources. Although several protocols have been reported to reduce postoperative stay, no Level I evidence exists for their use...
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Veröffentlicht in: | Diseases of the colon & rectum 2003-07, Vol.46 (7), p.851-859 |
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container_title | Diseases of the colon & rectum |
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creator | DELANEY, Conor P ZUTSHI, Massarat SENAGORE, Anthony J REMZI, Feza H HAMMEL, Jeffrey FAZIO, Victor W |
description | In an era of dwindling hospital resources and increasing medical costs, safe reduction in postoperative stay has become a major focus to optimize utilization of healthcare resources. Although several protocols have been reported to reduce postoperative stay, no Level I evidence exists for their use in routine clinical practice.
Sixty-four patients undergoing laparotomy and intestinal or rectal resection were randomly assigned to a pathway of controlled rehabilitation with early ambulation and diet or to traditional postoperative care. Time to discharge from hospital, complication and readmission rates, pain level, quality of life, and patient satisfaction scores were determined at the time of discharge and at 10 and 30 days after surgery. Subgroups were defined to evaluate those who derived the optimal benefit from the protocol.
Pathway patients spent less total time in the hospital after surgery (5.4 vs. 7.1 days; P = 0.02) and less time in the hospital during the primary admission than traditional patients. Patients younger than 70 years old had greater benefits than the overall study group (5 vs. 7.1 days; P = 0.01). Patients treated by surgeons with the most experience with the pathway spent significantly less time in the hospital than did those whose surgeons were less experienced with the pathway (P = 0.01). There was no difference between pathway and traditional patients for readmission or complication rates, pain score, quality of life after surgery, or overall satisfaction with the hospital stay.
Patients scheduled for a laparotomy and major intestinal or rectal resection are suitable for management by a pathway of controlled rehabilitation with early ambulation and diet. Pathway patients have a shorter hospital stay, with no adverse effect on patient satisfaction, pain scores, or complication rates. Patients younger than 70 years of age derive the optimal benefit, and increased surgeon experience improves outcome. |
doi_str_mv | 10.1007/s10350-004-6672-4 |
format | Article |
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Sixty-four patients undergoing laparotomy and intestinal or rectal resection were randomly assigned to a pathway of controlled rehabilitation with early ambulation and diet or to traditional postoperative care. Time to discharge from hospital, complication and readmission rates, pain level, quality of life, and patient satisfaction scores were determined at the time of discharge and at 10 and 30 days after surgery. Subgroups were defined to evaluate those who derived the optimal benefit from the protocol.
Pathway patients spent less total time in the hospital after surgery (5.4 vs. 7.1 days; P = 0.02) and less time in the hospital during the primary admission than traditional patients. Patients younger than 70 years old had greater benefits than the overall study group (5 vs. 7.1 days; P = 0.01). Patients treated by surgeons with the most experience with the pathway spent significantly less time in the hospital than did those whose surgeons were less experienced with the pathway (P = 0.01). There was no difference between pathway and traditional patients for readmission or complication rates, pain score, quality of life after surgery, or overall satisfaction with the hospital stay.
Patients scheduled for a laparotomy and major intestinal or rectal resection are suitable for management by a pathway of controlled rehabilitation with early ambulation and diet. Pathway patients have a shorter hospital stay, with no adverse effect on patient satisfaction, pain scores, or complication rates. Patients younger than 70 years of age derive the optimal benefit, and increased surgeon experience improves outcome.</description><identifier>ISSN: 0012-3706</identifier><identifier>EISSN: 1530-0358</identifier><identifier>DOI: 10.1007/s10350-004-6672-4</identifier><identifier>PMID: 12847356</identifier><identifier>CODEN: DICRAG</identifier><language>eng</language><publisher>Secaucus, NJ: Springer</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Colectomy - rehabilitation ; Critical Pathways ; Early Ambulation ; Feeding Methods ; Female ; Humans ; Ileostomy ; Laparotomy ; Length of Stay ; Male ; Medical sciences ; Middle Aged ; Patient Readmission ; Patient Satisfaction ; Postoperative Care - methods ; Prospective Studies ; Quality of Life ; Stomach, duodenum, intestine, rectum, anus ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system</subject><ispartof>Diseases of the colon & rectum, 2003-07, Vol.46 (7), p.851-859</ispartof><rights>2004 INIST-CNRS</rights><rights>The American Society of Colon and Rectal Surgeons 2003</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c354t-a4425421025f18f58442000467772497f3df950aca25a856a296858a14208a103</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14980350$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12847356$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>DELANEY, Conor P</creatorcontrib><creatorcontrib>ZUTSHI, Massarat</creatorcontrib><creatorcontrib>SENAGORE, Anthony J</creatorcontrib><creatorcontrib>REMZI, Feza H</creatorcontrib><creatorcontrib>HAMMEL, Jeffrey</creatorcontrib><creatorcontrib>FAZIO, Victor W</creatorcontrib><title>Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection</title><title>Diseases of the colon & rectum</title><addtitle>Dis Colon Rectum</addtitle><description>In an era of dwindling hospital resources and increasing medical costs, safe reduction in postoperative stay has become a major focus to optimize utilization of healthcare resources. Although several protocols have been reported to reduce postoperative stay, no Level I evidence exists for their use in routine clinical practice.
Sixty-four patients undergoing laparotomy and intestinal or rectal resection were randomly assigned to a pathway of controlled rehabilitation with early ambulation and diet or to traditional postoperative care. Time to discharge from hospital, complication and readmission rates, pain level, quality of life, and patient satisfaction scores were determined at the time of discharge and at 10 and 30 days after surgery. Subgroups were defined to evaluate those who derived the optimal benefit from the protocol.
Pathway patients spent less total time in the hospital after surgery (5.4 vs. 7.1 days; P = 0.02) and less time in the hospital during the primary admission than traditional patients. Patients younger than 70 years old had greater benefits than the overall study group (5 vs. 7.1 days; P = 0.01). Patients treated by surgeons with the most experience with the pathway spent significantly less time in the hospital than did those whose surgeons were less experienced with the pathway (P = 0.01). There was no difference between pathway and traditional patients for readmission or complication rates, pain score, quality of life after surgery, or overall satisfaction with the hospital stay.
Patients scheduled for a laparotomy and major intestinal or rectal resection are suitable for management by a pathway of controlled rehabilitation with early ambulation and diet. Pathway patients have a shorter hospital stay, with no adverse effect on patient satisfaction, pain scores, or complication rates. Patients younger than 70 years of age derive the optimal benefit, and increased surgeon experience improves outcome.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Colectomy - rehabilitation</subject><subject>Critical Pathways</subject><subject>Early Ambulation</subject><subject>Feeding Methods</subject><subject>Female</subject><subject>Humans</subject><subject>Ileostomy</subject><subject>Laparotomy</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Patient Readmission</subject><subject>Patient Satisfaction</subject><subject>Postoperative Care - methods</subject><subject>Prospective Studies</subject><subject>Quality of Life</subject><subject>Stomach, duodenum, intestine, rectum, anus</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><issn>0012-3706</issn><issn>1530-0358</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkc9u1DAQxi0EosvCA3BBFhI9NeC_cXJEFQWkSnCAszWbTLSunDjYTlfL8_FgON2VirjYntFvPn-aj5DXnL3njJkPiTOpWcWYquraiEo9IRuuZelI3TwlG8a4qKRh9QV5kdJdKZlg5jm54KJRRup6Q_58jyHN2GV3j1c0wtSH0f3G_op2YcoxeI89zdGBpzvMB8SJAp0h7w9wpGH4l4q4h53zLkN2YaIHl_cUIfojhXG3-FO3fEB7h_nhkSP0bm0X9TmkHGaMsDqhHUSkMGSM1MMMMeQwHh9m3JQxZbeOREyr8TC9JM8G8Alfne8t-Xnz6cf1l-r22-ev1x9vq05qlStQSmglyhL0wJtBN6VmZXm1MUao1gyyH1rNoAOhodE1iLZudAO8YOVkcksuT7pzDL-WYsOOLnXoPUwYlmSNVFrxstktefsfeBeWWDwnK7hitVStKBA_QV2JIEUc7BzdCPFoObNrvvaUry0W7ZqvVWXmzVl42Y3YP06cAy3AuzMAqQM_lEQ7lx451TarpvwL4dixCg</recordid><startdate>20030701</startdate><enddate>20030701</enddate><creator>DELANEY, Conor P</creator><creator>ZUTSHI, Massarat</creator><creator>SENAGORE, Anthony J</creator><creator>REMZI, Feza H</creator><creator>HAMMEL, Jeffrey</creator><creator>FAZIO, Victor W</creator><general>Springer</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20030701</creationdate><title>Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection</title><author>DELANEY, Conor P ; ZUTSHI, Massarat ; SENAGORE, Anthony J ; REMZI, Feza H ; HAMMEL, Jeffrey ; FAZIO, Victor W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c354t-a4425421025f18f58442000467772497f3df950aca25a856a296858a14208a103</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Colectomy - rehabilitation</topic><topic>Critical Pathways</topic><topic>Early Ambulation</topic><topic>Feeding Methods</topic><topic>Female</topic><topic>Humans</topic><topic>Ileostomy</topic><topic>Laparotomy</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Patient Readmission</topic><topic>Patient Satisfaction</topic><topic>Postoperative Care - methods</topic><topic>Prospective Studies</topic><topic>Quality of Life</topic><topic>Stomach, duodenum, intestine, rectum, anus</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>DELANEY, Conor P</creatorcontrib><creatorcontrib>ZUTSHI, Massarat</creatorcontrib><creatorcontrib>SENAGORE, Anthony J</creatorcontrib><creatorcontrib>REMZI, Feza H</creatorcontrib><creatorcontrib>HAMMEL, Jeffrey</creatorcontrib><creatorcontrib>FAZIO, Victor W</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Diseases of the colon & rectum</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>DELANEY, Conor P</au><au>ZUTSHI, Massarat</au><au>SENAGORE, Anthony J</au><au>REMZI, Feza H</au><au>HAMMEL, Jeffrey</au><au>FAZIO, Victor W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection</atitle><jtitle>Diseases of the colon & rectum</jtitle><addtitle>Dis Colon Rectum</addtitle><date>2003-07-01</date><risdate>2003</risdate><volume>46</volume><issue>7</issue><spage>851</spage><epage>859</epage><pages>851-859</pages><issn>0012-3706</issn><eissn>1530-0358</eissn><coden>DICRAG</coden><abstract>In an era of dwindling hospital resources and increasing medical costs, safe reduction in postoperative stay has become a major focus to optimize utilization of healthcare resources. Although several protocols have been reported to reduce postoperative stay, no Level I evidence exists for their use in routine clinical practice.
Sixty-four patients undergoing laparotomy and intestinal or rectal resection were randomly assigned to a pathway of controlled rehabilitation with early ambulation and diet or to traditional postoperative care. Time to discharge from hospital, complication and readmission rates, pain level, quality of life, and patient satisfaction scores were determined at the time of discharge and at 10 and 30 days after surgery. Subgroups were defined to evaluate those who derived the optimal benefit from the protocol.
Pathway patients spent less total time in the hospital after surgery (5.4 vs. 7.1 days; P = 0.02) and less time in the hospital during the primary admission than traditional patients. Patients younger than 70 years old had greater benefits than the overall study group (5 vs. 7.1 days; P = 0.01). Patients treated by surgeons with the most experience with the pathway spent significantly less time in the hospital than did those whose surgeons were less experienced with the pathway (P = 0.01). There was no difference between pathway and traditional patients for readmission or complication rates, pain score, quality of life after surgery, or overall satisfaction with the hospital stay.
Patients scheduled for a laparotomy and major intestinal or rectal resection are suitable for management by a pathway of controlled rehabilitation with early ambulation and diet. Pathway patients have a shorter hospital stay, with no adverse effect on patient satisfaction, pain scores, or complication rates. Patients younger than 70 years of age derive the optimal benefit, and increased surgeon experience improves outcome.</abstract><cop>Secaucus, NJ</cop><pub>Springer</pub><pmid>12847356</pmid><doi>10.1007/s10350-004-6672-4</doi><tpages>9</tpages></addata></record> |
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subjects | Adult Aged Biological and medical sciences Colectomy - rehabilitation Critical Pathways Early Ambulation Feeding Methods Female Humans Ileostomy Laparotomy Length of Stay Male Medical sciences Middle Aged Patient Readmission Patient Satisfaction Postoperative Care - methods Prospective Studies Quality of Life Stomach, duodenum, intestine, rectum, anus Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the digestive system |
title | Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection |
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